Hour11 Flashcards
Spina Bifida
tuft of hair o dimple where buttcheeks separate
skin is closed
Meningocele
bulge meninges sac of CSF with no nerve involvement no paralysis
Myelomeningoclele
protrusion of meninges with CSF + nerves
-more likely to have bowel problems, paralysis + weakness
-Increased concern for infections
Screening for spina bifida + Detection
16 to 18 weeks/ Alpha fetoprotein test
Repair for Spina
48-72hrs
Nursing Care for spina
PROTECT TISUES WITH STERILE MOIST DRESSING+ OCCLUSIVE.
Postiion child prone off defect
Kidney rt spina
urinary catheter to prevent infect
Crede Bladder
suprapubic so that you aren’t positiong the child on their defect to re cath often
Neurological rt Post op spina
Check finger+ toes, rooting
Chek ICP
VP shunt: drains out the fluid and decrease ICP
Hydrocephalus: pressure cause brain/skull seen in myelomeningcole pts look for ICP increased, blocked shunt, leaking CSF, head circumference
Hydrocephalus ( define/ s+s)
increased fluid in ventricles they route CSF in brain.causing the ventricles to enlarge which puts pressure on the brain tissue resulting in brain damage
s/s = head circumference
Bulging Fontanels
irritability, high pitched cry, nuchal rigidity
vomiting
feeding difficulties
increased frontal lobe
plate scratching sound
transillumination = increased red in head
sunset sign= eyes appear downward ; white of eye visible
prominent veins
Childhood(4) vs Infancy (10) Hydrocephlaus s/s
Infancy: skull veins, increased ICP, cry, irritable, increased head circumference, bludging anterior fontalles, cracked pot sound
transillumination = increased red in head
sunset eyes - eyes deviate downward
Childhood
Focal manifestation
Headache
Irritable
Confused
Tx of hydro
a shunt is inserted to drain into peritonea cavity
mointo for chnage in neurlogical status
Post op VP SHUNT (6)
postion off shunt
continue assements for meningitis
ICP increased
Blocked shunt
Leaking CSF ( halo or glucose test) * what color should it be?*
Head Circumference
Cleft Lip
development of lip isnt developed in utero can see in ultrasound
can be complete (involvement nasal passage) or incomplete
Nurse/Delivery for cleft lip
keep neural face and reaction
Pre-op Care for cleft lip
support family
can breastfeed with adaptations to stimulate deeding and mom pumps
meet infant sucking need with pacificer usage during g tube
Feed upright
skin stretchers may inserted prior surgery to increase amount of skin available to graft to ne areas
Piegon bottles
BURP FREQUENTLY
Complications rt cleft lip (4)
Aspiration pneumonia
FTT
Decreased bonding
Infections (ear + respiratory)
Post Op care rt cleft lip (7)
Positioning SUPINE ONLY
Logan Bow/bar = protect inscions - remove during feedings
Rinse mouth after feeding, incsion+ wound care
Arm restraints to prevent touching of site
HOB up (infant seat) help decrease swelling / propped on side
Feeding resumes when cleared
NO SPOONS ( requires movement of lips)
Prevent crying (bonds+ pain meds)
Post-op complications rt cleft lip + plate (5)
Infection (ear+ lung dt opening)
Disruption of suture line
Speech problems
FTT
nutrition alterations
Cleft Palate
Incomplete closure of palate @9 weeks gestation
Surgical interventions (cleft palate)
Between 1-2 1/2
Before speech patterns
Preop Cleft Palate (think about feeding)
BURP MORE FREQUENTLY
Retainer; special nipple for feeding
Long, soft nipples and bottles ( plastic or silicone spoon)
May use GT ensure adequate intake
Post Op Cleft Palate
Oral care, protect site
Pain relief , no specially postion requirements
No-No ( restraints)
Games to develop speech/word
SOFT foods . careful with spoon
Tracheoesophageal Fistula and Esophageal Atresia
TEF: abnormal connection between upper part of esophagus and trachea/windpipe
EA: when upper part of esophagus does not connect with lower esophagus/stomach
S/s of TEA + EA
3 C’s = cough, choking, cyanosis with first feed
Frothy saliva in mouth _nose, drooling
Monitor first fed stop immediately notify MD
Respiratory Distress during feeding
Abdominal distention
Aspiration pneumonia
IVF, G tube
Pyloric Stenosis:
hypertrophy (enlargement of muscle around sphincter) and hyperplasia (enlargement
of tissue) of pyloric sphincter
decreases flow of food through pylorus from stomach to duodenum
S/S of Pyloric Stenosis
3wks: regurgitation of breast + formula
-4-6wks: projectile vomiting in healthy infant (up to 3hrs after eating), no bile in vomit
- May progress to malnutrition, metabolic alkalosis hypokalemia , dehydration (sunken fonatlle)
, FTT ( nto retaining anything)
- May feel olive sized firmness at pylorus Palpable right epigastric region ( hypertriphied pllorus )
- See waves of peristalsis across abdomen
Treatment Pyloric Stenosis (3)
Least invasive to first
1. thickened foods, elevated 30 minute after eating
- Endosopcic dilation = ballon inserterd to expand opening
- Laparoscopic plyrmyotomy : cuts muscle thru abdomen
Nurse Dej job POST OP rt Pyloric Stenosis (6)
-Fluid and electrolyte balance
-Daily weights
- Meet infant needs: bonding, pain relief
- Oral feedings immediately after surgery (Breastfeed/formula)
Clear liquids and advance as tolerated ( 1/2 strength then full stength )
- No pacifier, Burp well- decrease air intake
HT rt pyloric stenosis Post op
Vomiting is normal
S/S dehydration , resuming BF/formula
Infection HRF SEPSIS
Hirschsprung’s Disease:
lack of normal peristalsis due to absence of autonomic parasympathetic
ganglion cells; No movement in bowels, leads to retention of stool, distention of bowels ( mechanical obstruction)
S/S rt Hirschsprung’s Disease (7)
think about newborns for first s/s!
Distended abdomen
Feeding intolerance
Billious vomit ( key difference)
Delay in passage of meconium
Constipation
Ribbon like stools
Enterocoliits
Nursing Responsibilities: Hirschsprung’s Disease Post Op
define
Removal of intestine+ Temporary colostomy.
S+S of wound infection + bowel obstruction
Appetite
Abdomen
Weight
Colostomy ( red+pink)
Intussusception:
telescoping of a portion of the intestine into an adjacent portion; common at six months to 6 yrs
compression on blood vessels leading to possible necrosis
Intussusception s/s (5)
sudden onset of abdominal cramp pain
bilious vomiting
tender distended abdomen at umblical area
currant jelly stool ( purple color , dark red), mucousy
LOOSE SCANT STOOLS
Tx of Intusssuscpetion
Liquid or air enema to “reopen intenstines” (ASAP)
Surgical repair if doesnt work
